Successful hysteroscopic management of two cases of interstitial pregnancy

Abstract

Introduction. Interstitial pregnancy (IP) is the rarest type of tubal pregnancy with a high rupture rate and often remains asymptomatic in the first 10?12 gestational weeks. Therefore, the timing of the diagnosis is crucial for successful management. Case report. Two patients, aged 28 and 22, were diagnosed with IP using transvaginal ultrasound. Both patients were asymptomatic, with initial serum ?hCG of 6,664 mIU/mL and 4,641 mIU/mL, respectively. Since they refused treatment with methotrexate and wanted to preserve their fertility, we performed operative hysteroscopy with resection and evacuation of the gestational tissue. The procedures were uneventful. The ?hCG levels dropped significantly, and the patients were discharged after three and four hospital days, respectively. Conclusion. Using hysteroscopic procedures, we successfully treated two asymptomatic patients with IP of gestational age < 10 weeks by ultrasonography and levels of serum ?hCG < 7,000 mIU/mL. With the occurrence of IP but also the numerous advantages of hysteroscopy, large, multicenter studies are necessary to further investigate the place of this approach as a single treatment method for IP. Trends and consequences observed during the COVID-19 pandemic correlate with the importance of timely diagnosis of ectopic pregnancies, the benefits of a minimally invasive approach in their treatment, and epidemiologically justified shorter hospital stays.